Abel Pharmboy's recent post remembering his father is evocative, emotional and an all around brilliant bit of writing. I can't help but note, DearReader, that his post strikes me hard as a father and as a son. I think it had a similar effect on many of his readers. There is an additional component, though, in that it puts a personal face on the motivations of those of us who work on issues related to substance abuse. It isn't a collection of incontrovertible data. No. It is a personal anecdote. But pain distributed is pain diffused. And the statistics loose much of their impact this way. This memorial of Abel's though. This is concentrated. And for those of you lucky enough to never have a substance dependent individual in your lives, perhaps even this is not enough. For many of us, however, only a couple of stories like this are sufficient justification.

When I think back, though, I believe you died some eight years earlier, just after your 50th birthday party. For your wife, my Mom, it was even long before that - she is a saint for staying with you as long as she did - no offense, Dad - and I know she still loves you no matter what.
Our family runs rich with depression and alcoholism but you died exceptionally early; my Dad - the young, fit, handsome fella you were in those pictures with little me at the Jersey shore, at home, or with me in that horrible Easter outfit - had died back then and was replaced for the last eight, ten, fourteen years by someone else.

In the late 80s I dabbled with speed to give me the energy to dance all night...Then came acid house and ecstasy. Suddenly, there was music that I loved complete with its own drug that let you dance like there was no tomorrow...As for the warnings against the drug... they didn't bother me. Everyone knew (Leah Betts) died because she drank too much water and her brain swelled up. She listened to the government scaremongering about the effects of ecstasy. Besides, I reasoned, I wasn't feckless. I combined my juvenile behaviour with very responsible jobs - until last year I was a manager with a charity. Also, as I got older I naturally went clubbing less and less.Then, last year I went to see the Pet Shop Boys play a benefit gig at Heaven. I hadn't been to a club for four years and after turning 40 had promised myself that I would grow up and start acting my age.

return to huntNo problem, right? Experienced clubber dude. Multiple Ecstasy experiences under his belt, ditto the amphetamine, maybe methamphetamine. Going about his daily life with no detrimental effects of his drug use, by his account. Not addicted, not damaged. "Knows his limits", I bet, all about the Ecstasy too. Opines on how safe recreational drug use is, no doubt. I know the type.

So, that evening I got home from work and got changed. And that's it. That's all I remember. A month later when I woke up I didn't even know I had left the house. I felt like the gig was about to start. I knew nothing about being in a coma, or my mum and brother deciding not to turn off my life-support machine. I didn't hear the discussions about what might happen if I woke up. I certainly did not know about my mum and brother being told on three occasions that I might die.
It transpired that I had taken powdered ecstasy, or MDMA, before going into Heaven.

-snip-

I later found out that I was one of four people in the hospital that weekend to have taken an E - and the only one to survive. My friend was told by a consultant that you could take E or MDMA 100 times and suffer no ill-effects or you could take it only once and that would be it.

Well, he doesn't remember exactly what happens and relates few details in the article. It sounds pretty familiar though, doesn't it? Seen to be dancing oddly, later collapsed. Found to have a sky high body temperature once under emergency care. Multiple organ failure. Read the case report literature and you'll find this is a depressingly familiar tale. The only thing unusual is that he survived. I wonder about that though. Easy to write up a case report when the subject dies in the ER. Not so easy to write up a many month history on someone who nearly died and then slowly recovered back toward normalcy.
Rare? Yes, the stats show that pretty clearly. The unfortunate Mr. Hennessy did not have dependence issues nor, going by his prior use, some unique constitutive factors. Alcoholism, in contrast, is not rare at all. Many of the more devastating personal effects of alcohol use result from dependence. Yet there is a common thread in that lives were disrupted by recreational drugs. Multiple lives, because most people have family and friends who care about them. Disrupted terribly. Sometimes for multiple generations.One at a time is a win. For me, anyway. So what if each new pharmacotherapy or other approach to treating alcoholism only works to get a few more percent of alcoholics clean? Each success is a big win for the family and friends. So what if MDMA-related medical emergencies and deaths are relatively rare? Rarer than equestrian accidents*? So what? Does it comfort the family to know that 10X or 100X or 1,000X more people died from various other causes when they are putting their loved one in the ground?
We don't yet generate magic bullets in the drug abuse fields. Most therapies- talk, pharmaco or other - don't work terribly well to rescue the drug-dependent. We know relatively little about precise danger thresholds when it comes to making predictions about acute toxicity in the individual recreational consumer. Yet...we make some progress. We design better therapies and invent new approaches...that pick up a few more percent of the population. We understand more about drug toxicities- in the case of MDMA this has a direct effect on user practices. Some users anyway.
And so we save a few more people. It is a Very Good Thing.
__
*and oh yes, we shall be taking up the unfortunately named Professor Nutt's issue at a later time, DearReader. Never fear.

I hate to say it, but that first person account sounds familiar to me. In fact, I've heard the same "first person" account many times with only the name changed. It's a "scared straight" story.
Anyone want to bet that you could give someone a pot of coffee and make them dance for hours in a sweaty, packed warehouse without drinking or taking a break and get an unhealthy rise in body temp?
I don't recommend taking homemade pills offered by strangers, but surely the solution is to make it available in a controlled dose and formulation with plenty of advice regarding how to handle it safely, like we do for alcohol?

I think in another ten years, there is going to be a lot of progress when it comes to treating addiction. I'm amazed at all the new neurotechnologies that are being invented. Deep transcranial magnetic stimulation has the capability of non-invasively stimulating the reward related regions of the brain. Also ultrasonic neuromodulation may be able to alter brain chemistry non-invasively with an even higher targeting accuracy than TMS. I would hope 30 years from now that addiction to drugs will be a thing of the past, relegated to the dustbin of evolutionary history.

The first story is very sad and I have compassion for the lives and families destroyed by addiction.
And though I have as much compassion for the individual in the second story, I don't understand the point you are trying to make there. He wasn't addicted, it was a one time event that happened to go terribly wrong. Are you advocating complete cessation of drugs in general, or just synthesized drugs of undetermined quality? You pointed out the rarity of adverse MDMA side effects compared with equestrian accidents--would you also want to stop people from riding horses? For some people, taking the occasional MDMA at a rave is as rewarding an experience as riding horses is to others. They know the risks and use in moderation just like a skydiver knows the risks, and taking enough precautions, continues to enjoy the experience.

I read this article independently this week as well. While it is clearly tragic, I wonder if its yet another story of PMA instead of MDMA. If four clubbers from the same place ended up in the emergency room, my guess is it was not MDMA. Without the tox screen its tough to tell. Its these kind of stories that MDMA as Schedule I rather than Schedule II as the PTSD trials suggest it should be.
I wish I had more information on this one.
Doc F.

I could regale you with first-person accounts of some of the wonderful drug experiences which have enriched my life, but those would just be meaningless anecdotes...
Yes, there are risks. There are always risks.

Stikes a little close to home. In highschool a classmate took his life stung out on something (it was not disclosed). It's a sad thing when young adults die of overdoses. A few weeks ago a fellow student died with a BAC over .5. It's been interesting on campus.

Mr. Gunn, it sounds familiar because, as I noted, the clinical outcome in the published case reports is quite similar. There are a handful of symptoms that appear over and over again. If you are proposing that you've heard this coma-long term recovery story before than please send me some cites or at least a country/city and a data. Because that part of this story is new to me.
The similarity of clinical outcome in cases where there is/is not other confounds such as rave/home environment, alcohol, cannabis, other amphetamines, high plasma levels/low plasma levels, high/low friend/self report of consumption, etc, etc is important. If MDMA is the sole consistent factor and the clinical profile is similar, it seriously questions your attempts to blame "homemade pills" and haig's blaming of "undetermined quality".
"plenty of advice how to handle it"? yeah, you got it. That's the point of science in the area of drug toxicology. trying to determine adverse effects and get as close as you can to determining dose thresholds, co-factors which both exacerbate and attenuate the effects, individual susceptibility, etc. Denying this science and going through wild gymnastics to avoid confronting the well supported hypothesis that MDMA itself is capable of causing acute and lasting harms, even when taken in "common recreational doses" is silly and you might even say counterproductive.
counterproductive because if you bleat on about how it has to be something other than the MDMA (in recreational doses) than the first example in which a death or coma or whatall occurs where such a case can be proved, you are screwed. Better to accept the underlying facts and hammer on about relative risk, in my view. (although it is also my view that advocates are incredibly naive about the role of such arguments in public policy and politics, this will be taken up once more, if I ever get to the Nutt affair)

Better to accept the underlying facts and hammer on about relative risk, in my view. (although it is also my view that advocates are incredibly naive about the role of such arguments in public policy and politics, this will be taken up once more, if I ever get to the Nutt affair)

Relative risk plays a grotesquely too-small role in discussions of public policy and politics. This is because partisans participating in such discussions know that nothing works better to sway public opinion than OUTRAGE!!!1111!! WHAT ABOUT THE CHILDREN!!111!!!!!ELEVENTY!!111!!, and nothing works worse than empirical quantitative relative risk assessment using as baseline the sorts of activities that we all accept as not unduly dangerous, such as driving in cars, swimming at the beach, etc.

I am not sure what is your stance on the issue.probably because i have no idea of the Dr.Nutt's article..(googled it but couldn't find it.Not patient enough to do a better search).. Agreed they are all very sad personal accounts...and by those standards i guess my mom would say i have been dead for 13 year since 14.... and please note i am not an addict, but have been depressed(not all the 13 years straight, but in a lot of phases guess that comes closest to schizo-affective disorder) Anyway my question/query being i consider myself as having been addicted to morbid/depressive imagination and/or visualization.. how clearly or well researched is that case/scenario?? I haven't come across anything of that during my cognitive neuropsychology course but would love to hear from ppl of other disciplines??

"So what if MDMA-related medical emergencies and deaths are relatively rare? Rarer than equestrian accidents*? So what?"
Because we don't hear about the people who are in comas from equestrian accidents. The media devotes time to the risks of drugs that is out of proportion to the risks of activities that people perform every day and are not stigmatised for doing so. People don't say "oh no one cares how many people die from taking ecstasy when they are burying their jodphur clad little equestrian". That was kind of the point of the article.

Well I have read this story before... in many different ways... I will not say much cause I know most people will not agree with me.
As with ANY drug (and this is directed to DrugMonkey) including Alcohol, Tabacco, Weed, MDMA and Benzos e whatnot there is ALWAYS a risk. With prescription pills the sideaffects are stated on the label but not with illegal drugs. IF those were more controlled, studied and available from a trusted source they are extremely safe. The number of deaths from MDMA, Weed and LSD combined would not reach half the deaths a year by alcohol or tabacco! Why not control those substances in the same way?

Well I have read this story before... in many different ways... I will not say much cause I know most people will not agree with me.
It is not a matter of "agreeing" with you or not. The question is which part of "this story" you've "read...before". If it is the coma and protracted recovery part, that's pretty interesting. This sort of thing does not appear in the Case Reports I've read. It's pretty salient so I would think it would stick in mind.
If you are talking about the acute medical consequences, well, NSS! You've read those before because that is what happens.

My own issue with MDMA is with the primary effects. Way back in college, I was at a druggie frat party. One of my friends took Ecstasy, and spent the evening telling people whatever he thought they wanted to hear... while showing remarkably poor judgment about what they wanted to hear! He himself later told me, "I lost a lot of friends that night".